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General NPI Number Information
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NPI Number | 1093469017
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Entity Type | Individual
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Provider Name | JOSHUA BENNETT PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 2450 CRAVEN ST BLDG 3300
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City | SAN DIEGO
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State | CA
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Zip | 92136-2226
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Country | US
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Telephone | 619-881-9202
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Fax |
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Provider Business Mailing Address
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Address Line | 2232 NW 196TH ST
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City | EDMOND
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State | OK
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Zip | 73012-3636
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Country | US
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Telephone | 858-245-0998
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 4748
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4748
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA64095
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License Number State | CA
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